Being a teenager is not a mental illness

In the field of mental health, a recurring problem is the difficulty in knowing the true extent of the prevalence of mental distress – terminology, definitions and statistics often confuse rather than illuminate the issue. This week it was the turn of the National Association of Head Teachers (NAHT) to contribute to this confusion.

According to the NAHT, one fifth of primary-school children have a mental-health problem. The NAHT claims that this not only causes problems in the present, but will, if left untreated, put children at increased risk of developing psychiatric problems later in life. With two thirds of primary schools saying they cannot deal with their pupils’ mental-health problems, the NAHT has called for more input from specialist mental-health services.

There does indeed appear to be a rise in childhood and adolescent mental distress. For example, over the past 10 years, inpatient admissions due to self-harm for people under 25 have increased from 22,555 in 2000-01 to 37,932 in 2010-11, an increase of 68 per cent. According to the 2007 Adult Psychiatry Morbidity in England report, the number of those reporting self-harm at some point in their lives increased from 2.4 per cent in 2000 to 3.8 per cent in 2007. Among women, this increase was concentrated in the youngest age group, with 6.5 per cent of women aged 16-24 reporting self-harm in 2000 compared with 11.7 per cent in 2007 (it then drops to under four per cent for the 25-35 age-group).

According to Lucie Russell of the mental-health charity Young Minds, ‘these shocking statistics should act as a wake-up call to everyone who cares about the welfare of young people. More and more children and young people are using self-harm as a mechanism to cope with the pressures of life and this just isn’t acceptable.’ For Catherine Roche, chief executive of the mental-health charity Place2Be, a key reason for this is that children ‘faced all sorts of challenges, such as coping with parental separation, the illness or death of a loved one, and dealing with substance abuse and domestic violence’. In response, the government has pledged £1.4 billion to improve mental-health services.

Roche is certainly correct, but then again children have always faced such issues – it hardly works as an explanation. And while there are those who talk about the unique problems of the current age, such as 24/7 social media, every new generation has had to deal with marked changes in society and advances in technology since the dawn of modernity. Are today’s children really facing more severe challenges than those growing up in postwar Britain?

Care needs to be taken in interpreting these figures. For example, a significant number of the admissions were likely due to alcohol or drugs, the misuse of which can be defined as self-harm. So the statistical rise in self-harm could partly be explained by a rise in alcohol consumption among the young. Yet, as I have argued previously on spiked, most young people view getting drunk as a rite of passage or as teenage experimentation, rather than as an act of deliberate self-harm. Likewise, many of the hospital admissions are repeat admissions, and the increase in reporting may partly reflect a greater willingness to admit to self-harming behaviour.

Nevertheless, the figures do appear to indicate a rise in the mental distress experienced by young people. As someone with two teenage children, I am no stranger to the problems young people face today. I’m also aware that many children will require professional mental-health input at some point in their lives, and some of them are likely to find that such problems worsen as they reach adulthood. For them, appropriate intervention is important and will hopefully allow them to address and resolve their problems. However, if such people are to be given an adequate service we need to drop the hyperbole and develop a more considered approach to how we classify and intervene in the lives of young people.

The exaggeration of the extent of the problem, by the likes of the NAHT and some mental-health charities, is unhelpful. The claim that one in five primary-school children has a mental-health problem conflates everyday instances of unhappiness with more severe mental distress. It is also double the figure usually cited. A 2004 report by the Office of National Statistics, which remains the main reference point for campaigners today, claims that one in ten children had a diagnosable mental disorder. But even here the figures aren’t all they seem. The most common ‘mental disorder’ cited in the report was ‘conduct disorder’, which includes such deeds and actions as being defiant, aggressive and/or exhibiting other forms of ‘anti-social’ behaviour. What the report terms the ‘less common disorders’, or what others would call the more serious ones, affected only 0.7 per cent of children.

Teenage years can be extremely painful. It is the time we try to forge an identity, come to terms with our changing relationship with our parents, make and lose friends, negotiate puberty and become aware of our sexuality. It is through dealing with these conflicts and dilemmas that we are able to make the transition to adulthood. In other words, adolescent angst is a normal aspect of growing up. Rather than recognising this, there is a trend towards encouraging more and more children and adolescents to view their problems through a psychiatric and/or psychological lens, whereby a wide array of emotions and behaviours are given a diagnostic label. How this helps the small minority who do require professional help is not at all clear, and is likely to be counterproductive as scarce resources are diverted from targeted intervention to a more scattergun approach.

This conflation and the problems that ensue from it can be very damaging. For instance, a recent article in The Times referenced the headline-grabbing figure, that one in five girls suffer ‘emotional disorders’, before going on to detail the tragic suicide of a teenage girl. There is simply no comparison between the distress that young girl was going through and the problems most young people encounter.

There are also some wider social factors to consider. In recent decades we have witnessed the erosion of adult authority; parents are increasingly informed by an array of politicians and self-appointed ‘experts’ that they lack the ability to raise their children properly. There has also been a concomitant decline in the authority of schoolteachers. With increased confusion over the best way to raise, educate and discipline children, perhaps what we are witnessing is the projection of adult anxieties on to children. In other words, it may be that the real problem resides in the adult world and our inability to deal with the problems confronting us, whether that be as a parent, teacher, professional or politician. In this respect, the outsourcing of responsibility to the psychiatric professions makes perfect sense. The problem is that the more we outsource to professionals, the less time professionals have to help the children who do require their help.

Ken McLaughlin is a senior lecturer in social work at Manchester Metropolitan University, England. His most recent book, Surviving Identity: Vulnerability and the Psychology of Recognition, is published by Routledge. (Buy this book from Amazon (UK).)

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